Kingswood Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

We inspected Kingswood Lodge on 1 May 2018 and the visit was unannounced. This meant the staff and the provider did not know we would be visiting.

Kingswood Lodge provides personal care and accommodation for up to 21 older people. On the day of our inspection there were 16 people living at the service. At the last inspection in January 2016, the service was rated ‘Good’. At this inspection, we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe living at Kingswood Lodge and felt safe with the staff team who supported them. The staff team had received training in the safeguarding of adults and knew their responsibilities for keeping people safe from avoidable harm. This included reporting their concerns to the registered manager and the management team.

People’s needs had been identified and the risks associated with their care and support had been assessed and reviewed. Action was taken and lessons learned when things went wrong. This made sure safety across the service continually improved.

Checks had been carried out on new members of staff to make sure they were suitable to work at the service and relevant training had been provided. People felt there were enough members of staff on duty each day because their care and support needs were being met. Their relatives agreed with what they told us.

The staff team felt supported by the registered manager and the management team. They were provided with the opportunity to share their views of the service through, day to day discussion, supervision and appraisals. Team meetings were also held.

People on the whole received their medicines as prescribed. Appropriate records were being kept and systems were in place to regularly audit the medicines held.

People were provided with a clean and comfortable place to live and there were appropriate spaces to enable people to either spend time on their own, or with others. Training in the prevention and control of infection had been completed by the staff team and the necessary protective personal equipment was available to use.

The registered manager had assessed people’s care and support needs prior to them moving into the service to make sure they could be met by the staff team. The staff team knew the needs of the people they were supporting because plans of care were in place which included people's personal preferences.

People's food and drink requirements had been assessed and a balanced diet was being provided. Records kept for people assessed as being at risk of not getting the food and drinks they needed to keep them well were kept up to date.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors and community nurses and they received on-going healthcare support.

Staff members were aware of their responsibilities under the Mental Capacity Act 2005 and people had been involved in making day to day decisions about their care and support. The staff team understood their responsibilities with regard to gaining people's consent to their car

We had a concern from the last inspection that staffing levels had not been maintained to fully meet people's needs, so we followed up this issue.

We spoke with five people living in the home at the time of the inspection. Whilst the majority of people spoke into told staff were available when needed, there were two comments received about staffing levels not always being sufficient to meet people's needs.

This was a mixed inspection. Most people living in the home said that staffing levels were sufficient. However, the provider agreed that staffing on some daytime and evening shifts was not at a sufficient level. He has now provided us with evidence that staffing has been increased on the shifts.

There were some issues of concern. Staff need to always explain to people in a respectful manner as to why some requests cannot be met. The manager needs to assess moving and handling practice for one person to ensure this is carried out safely.

We had a concern from the last inspection that people’s dignity and care were not always respected, so we followed up these issues.

We spoke with eleven people living in the home at the time of the inspection. A large majority told us that that were satisfied with the care that staff provided them with.

A person told us that she was happy living in the home: ‘’Staff are good. They have always treated me properly‘’. Another person said: ‘’Most of the staff are friendly. One staff member needs to be friendlier’’.

We spoke with the relatives of five people. They all told us that they thought their relatives received good care.

One relative said; “Staff have always treated my mother well. It is much better here than the other home she was in’’.

We spoke with a community nurse. She said she had never seen anything which had concerned her.

Overall this was a positive inspection. Most people living in the home and all the relatives we spoke with said that they had been satisfied with care. We saw that people received swift medical attention if they were injured.

There were some issues of concern. Staffing levels needed to be maintained at all times to ensure people did not have to wait a long time to have their care needs met. The manner of a small number of staff needed to be improved, to ensure proper respect is shown to people at all times.

We spoke with eight people living in the home at the time of the inspection. Opinions were divided as to people being satisfied with the care they received.

A person told us that he had no problems: ‘’Staff come quickly if I need them‘’. Another person said: ‘’I don't like it when some staff speak down to me’’.

We spoke with the relatives of two people. They all told us that they thought care was good and staff were always welcoming.

One relative said; “I have never seen anything that concerned me’’.

We received some comments of concern: four people said that the attitude of some staff was not good. They said that some staff had been abrupt and impatient.

We spoke with a community nurse. She said staff were good at alerting them as needed, they were helpful, and they used equipment appropriately. However, the manner of some of the staff was stern. They told people what to do rather than encouraged them.

This was a mixed inspection. Half the people living in the home and relatives we spoke with said that they were satisfied with care. However, the other half of the people told us that they were concerned with the attitude of some staff. The service needs to ensure that the attitude of staff is always calm and friendly and that people receive swift medical attention if they are injured.

We spoke with eight people living in the home at the time of the inspection. Most people said that they were satisfied with the care they received.

A person told us that staff were helpful and friendly: ‘’Staff try their best ‘’.

We spoke with five relatives. They all told us that the care provided was of a high standard and that staff were always friendly.

One relative said; “I have no concerns. There is always a good atmosphere in the home ’’.

We received some comments of concern: three people said that some staff did not take care when moving them. They were not deliberately harmful but they could be gentler. One person said that some residents got more favourable treatment than her.

This was a mixed inspection. Most people living in the home and their relatives, said that they were satisfied or mainly satisfied with care. However, we found that most of the essential standards we inspected were not met. The service needs to ensure that care always meets people’s needs, fire precautions are fully in place, proper infection control measures are always followed, and medication is properly administered. Premises need to be upgraded, all necessary equipment needs to be in place, that people’s information is kept confidentially, and proper quality assurance is carried out to ensure high standards at all times.

People told us that they were happy with the care and support they received from the staff at Kingswood Lodge, one person explained, “the staff are alright, they’re very good”.

We were told that people felt safe living at the service, one person explained, “I like it because I’ve got no concerns and that means that my son doesn’t worry”.

People told us that they were happy with the facilities provided within Kingswood Lodge, one person told us, “It’s very comfortable here”.

During our visit we observed staff providing support in a relaxed and friendly manner.

People told us that they had been given the opportunity to look around the service before deciding to move in, one person explained, "My son came and looked around because I kept falling, he said this is the best one, I think it was an excellent move, every thing’s done for you, meals are cooked, washing is done, everything”.

People living at Kingswood Lodge told us that on the whole they were happy with the care and support they were receiving, one person told us, “I’m looked after very well, I have nothing but praise for them” another person explained, I’m very satisfied with the place, my family visit me and their happy because I’m happy”.

People spoken with told us that on the whole, they were treated with respect, One person explained, “The staff are very nice, there’s the odd one that doesn’t talk to you like the others, but the others are really nice” another person told us, “I’m treated with respect, one person occasionally doesn’t, but on the whole they are very good”.

People told us that they liked the food that was provided and they had a choice at meal times. One person explained, “The food is really good, I have no complaints about it”, another person told us, “The food’s nice and you get a choice”.

People told us that they felt safe living at Kingswood Lodge, one person told us, “They can tell when you are not happy and they come and find out why”; another person explained “I feel very safe”.

We carried out our inspection on 14 and 15 January 2016. The inspection was unannounced.

Kingswood Lodge provides accommodation for up to 21 older people. The provider had applied to the Care Quality Commission to increase their capacity to accommodate up to 33 older people. This application was under consideration at the time of our inspection.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they felt safe at Kingswood Lodge. They felt safe because of their confidence in staff’s ability to meet their needs. Staff were deployed based on people’s level of need. Staff told us that the staffing levels were mostly sufficient to allow them meet the needs of people using the service.

We reviewed people’s records and carried out observations which showed that people received their medicines as prescribed by their doctor.

Staff had effective induction and training that equipped them with the skills they required to look after people.

Staff understood the Mental Capacity Act (MCA) 2005 and how they would practice it in their role. We observed that they sought people’s consent before they provided care and treatment. However, we reviewed records that showed that people’s mental capacity assessment were not completed to reflect which decisions that they could make independently or those that they required further support to make.

People told us they liked their meals. They had access to a choice of nutritious meals. Staff provided additional support to meet people’s nutritional needs where this was required.

People had prompt access to health care services when required. We reviewed records which showed that staff did not always correctly follow guidelines as advised by health care professionals.

People were complimentary of the caring attitudes of the staff. They said staff made them feel like they mattered. Staff respected their dignity and human rights. They also promoted people’s right to privacy.

The relatives and friends of people using the service had no restrictions to visiting Kingswood Lodge.

People’s care plans reflected their individual needs. Their care was provided in a person centred manner. The provider listened to feedback from people using the service and their relatives. People told us that staff acted promptly on their feedback.

Staff felt supported by the registered manager. People using the service had easy access to the manager. The provider had effective procedures for monitoring and assessing the quality of service that people received.